ABSTRACT
Rectal cancer, defined as a tumour with its lower edge less than 15 cm from the anal verge, is a common disease, and accounts for over 30% of all cancers of the large bowel, with approximately 10 000 new cases per year. The rectum is relatively inaccessible, and surgery for rectal cancer is technically demanding, with a high morbidity and mortality for all abdominal procedures. Some early tumours can be treated by either peranal excision or by more recent developments such as transanal endoscopic microsurgery, but over 90% require an abdominal approach by either anterior resection (AR) or abdominoperineal excision (APE). An outstanding feature of rectal cancer surgery is the large variation in the rate of local recurrence: from 3% to 33%.1 The best results have been consistently reported from units who perform total mesorectal excision (TME) in patients with rectal cancer,1 a technique popularized by Heald.2
